Registered Nurse - Manager - Healthcare Quality

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary • Must Reside in Illinois*** • Must hold a Clinical License The Manager of Health Care Quality will support the functions of the Illinois Fully Integrated Duals Eligible (FIDE) quality program, including regulatory deliverables, HEDIS activities and reporting and other quality improvement activities. Be a collaborative partner with internal and external stakeholder to facilitate daily quality improvement (QI) functions. • Coordinate and monitor quality improvement projects from inception to closure including quality withhold performance, NCQA accreditation and contract compliance. • Develop the annual quality workplan to include program activities. • Support population health management and health equity activities to address inequities aimed to reduce disparities. • Monitor all workplan activities to ensure state, federal and NCQA compliance. • Ensure all quality policies are updated annually and in compliance with state contract. • Collaborate with all internal and external stakeholders to identify, develop, and implement innovative programs and initiatives to improve outcomes. • Manage medical record review and compile reports for both committee presentation and state submission. • Analyze data, develop reports and present to plan committees. • Adhere to NCQA standards and work with the National Quality Management Accreditation team to maintain the plan's NCQA accreditation. • Support the coordination of corporate compliance and external surveys as needed. • Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure. • Active member of quality committees to drive improvement efforts. • Participates in external quality review audits. Required Qualifications • 3+ years of quality improvement experience • Active Illinois nursing license or other clinical license • Experience managing HEDIS, CMS Stars and CAHPS activities. • Knowledge of NCQA accreditation standards • Experience managing multiple projects • Must reside in the state of Illinois Preferred Qualifications • Experience with NCQA Health Plan survey preparation and submission • Certified Professional in Healthcare Quality (CPHQ) Education • Bachelor’s degree in health-related field Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $66,330.00 - $145,860.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 11/10/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.